Cover photograph by Gonzalo Ruiz-Esquide, MD
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Clinicians rarely have time to fully evaluate and implement all of the screening and preventive services that professional organizations recommend. In this proof-of-concept study, the authors describe a method for ranking preventive services according to increases in life expectancy of patients with different demographic characteristics, medical conditions, and lifestyle choices. These predictions may help clinicians prioritize screening and preventive services at the patient level.
Celiac disease is associated with an increased risk for lymphoproliferative malignancy (LPM). Whether this risk is affected by documentation of mucosal healing on follow-up intestinal biopsy is unknown. In this evaluation of biopsy reports among patients with celiac disease from all pathology laboratories in Sweden, the risk for LPM was increased when follow-up biopsies showed persistent villous atrophy. Follow-up biopsies may be useful in identifying patients with celiac disease at increased risk for LPM.
Chronic diseases can be expensive and difficult to treat. From 6 clinics in Minnesota, 2135 patients with diabetes, hypertension, or heart failure received care goals and were randomly assigned to work with or without a care guide, a layperson who received brief training about these diseases and behavior change, to achieve the goals. After 1 year, care guide patients had achieved more goals and had fewer unmet goals than usual care patients. The estimated cost for this care model was $286 per patient. Lay care guides might help improve care for some patients with chronic disease.
Guidelines recommend self-monitoring of blood pressure for adults with hypertension. This review of 52 comparative studies evaluated the effectiveness of self-monitoring with or without additional support in such patients. For self-monitoring alone versus usual care, moderate-strength evidence supports a lower BP with self-monitoring at 6 months but not 12 months. For self-monitoring plus additional support versus usual care, high-strength evidence supports a lower BP with use of self-monitoring. For self-monitoring plus additional support versus self-monitoring alone or with less intense additional support, low-strength evidence fails to support a difference.
Differential verification in a diagnostic study is when different reference standards are used in different groups of participants. It can cause severely biased accuracy estimates of the test or model being studied. This article classifies types of differential verification, explores how they can lead to bias, and provides guidance on how to clearly report results when differential verification is present and how to assess and correct for the risk of bias.
This Update summarizes studies published in 2012 that the authors consider highly relevant to the practice of women's health. Topics include reproductive health, menopause, prevention and screening, and osteoporosis and bone health.
The U.S. Preventive Services Task Force recommends that clinicians screen adults aged 18 years or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions. The Task Force considered current evidence insufficient to assess the balance of benefits and harms of primary care–based screening and behavioral counseling interventions to reduce alcohol misuse in adolescents.
On 31 March 2013, Chinese public health authorities notified the World Health Organization of the isolation of influenza A(H7N9) virus from 3 critically ill adults. This avian influenza virus had never before been detected in humans, and its association with severe disease shocked experts. This commentary asks whether we should be concerned and whether we are fully prepared for a pandemic.
The American Psychiatric Association has released the long-awaited fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This commentary notes that the DSM-5 introduced several high-prevalence diagnoses at the fuzzy boundary with normality and recommends that physicians use the DSM-5 cautiously, if at all.
In this issue, Taksler and colleagues address the problem of prioritizing screening and preventive services in the limited time of a clinical encounter. The editorialists discuss the study and its findings and conclude that Taksler and colleagues' tool has promise to help identify the highest-impact interventions.
In this issue, Adair and colleagues examine whether a lay guide could improve care for chronic conditions. The editorialist discusses the study and applauds the authors for shedding light on a challenge the clinician struggles with every day—how to help patients with chronic diseases meet their health care goals.